In this systematic review, we looked at the rate of urine leakage from the kidney after surgical removal of kidney tumors. Urine leak (UL) is a common post-operative complication of partial nephrectomy (PN). The reported incidence varies in the literature, and there are no well-established guidelines for management of UL after PN. The goal of this study is to report the incidence and most common management strategies for UL after PN. For our quantitative synthesis, a systematic review of articles related to UL after PN from April 2010 to April 2020 was performed using PubMed and EMBASE. 475 total records were found, of which 40 reported on post-operative UL. A total of 19,904 cases were included. The overall incidence of UL was 2.8% (554/20,140). UL was most common in open cases (5.01%), followed by laparoscopic (4.40%) and robotic (1.18%) PN. Thirty-one of the included studies reported on management technique for a total of 343 interventions. UL was most frequently managed non-operatively (46.6%). Other management strategies included cystoscopy with ureteral stent placement (39.4%), percutaneous drain placement (8.7%), and percutaneous nephrostomy tube placement (2.3%). Use of nephrectomy, open reconstruction, angioembolization, or ureteroscopic techniques was uncommon (3.1%). Our study revealed that UL is rare after robotic approach to PN. Many reported cases have been managed conservatively. A stepwise management strategy is recommended. Most of these leaks heal with time or with placement of a stent into the ureter after surgery. We found that urine leak is less common with robotic surgery versus open or laparoscopic surgery.
| Published in | International Journal of Clinical and Experimental Medical Sciences (Volume 9, Issue 2) |
| DOI | 10.11648/j.ijcems.20230902.13 |
| Page(s) | 29-41 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2023. Published by Science Publishing Group |
Partial Nephrectomy, Robotic Surgery, Urine Leak, Urinoma, Urinary Fistula, Robot-Assisted Partial Nephrectomy
| [1] | Capitanio U, Bensalah K, Bex A, Boorjian SA, Bray F, Coleman J, Gore JL, Sun M, Wood C, Russo P Epidemiology of renal cell carcinoma. European urology 75 (1): 74-84. |
| [2] | Alam R, Patel HD, Osumah T, Srivastava A, Gorin MA, Johnson MH, Trock BJ, Chang P, Wagner AA, McKiernan JM (2019) Comparative effectiveness of management options for patients with small renal masses: a prospective cohort study. BJU international 123 (1): 42-50. |
| [3] | Leibovich BC, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H (2004) Nephron sparing surgery for appropriately selected renal cell carcinoma between 4 and 7 cm results in outcome similar to radical nephrectomy. The Journal of urology 171 (3): 1066-1070. |
| [4] | Campbell S, Uzzo RG, Allaf ME, Bass EB, Cadeddu JA, Chang A, Clark PE, Davis BJ, Derweesh IH, Giambarresi L (2017) Renal mass and localized renal cancer: AUA guideline. The Journal of urology 198 (3): 520-529. |
| [5] | Alameddine M, Koru-Sengul T, Moore KJ, Miao F, Sávio LF, Nahar B, Prakash NS, Venkatramani V, Jue JS, Punnen S (2019) Trends in utilization of robotic and open partial nephrectomy for management of cT1 renal masses. European urology focus 5 (3): 482-487. |
| [6] | Leow JJ, Heah NH, Chang SL, Chong YL, Png KS (2016) Outcomes of robotic versus laparoscopic partial nephrectomy: an updated meta-analysis of 4,919 patients. The Journal of urology 196 (5): 1371-1377. |
| [7] | Yang Y (2020) Partial Versus Radical Nephrectomy in Patients with Renal Cell Carcinoma: A Systematic Review and Meta-analysis. Urology Journal 17 (2): 109-117. |
| [8] | Erlich T, Abu-Ghanem Y, Ramon J, Mor Y, Rosenzweig B, Dotan Z (2017) Postoperative urinary leakage following partial nephrectomy for renal mass: risk factors and a proposed algorithm for the diagnosis and management. Scandinavian Journal of Surgery 106 (2): 139-144. |
| [9] | Peyton CC, Hajiran A, Morgan K, Azizi M, Tang D, Chipollini J, Gilbert SM, Poch M, Sexton WJ, Spiess PE (2020) Urinary leak following partial nephrectomy: a contemporary review of 975 cases. Can J Urol 27 (1): 10118-10124. |
| [10] | Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS med 6 (7): e1000097. |
| [11] | Mari A, Campi R, Schiavina R, Amparore D, Antonelli A, Artibani W, Barale M, Bertini R, Borghesi M, Bove P (2019) Nomogram for predicting the likelihood of postoperative surgical complications in patients treated with partial nephrectomy: a prospective multicentre observational study (the RECOR d 2 project). BJU international 124 (1): 93-102. |
| [12] | Zargar H, Khalifeh A, Autorino R, Akca O, Brandao LF, Laydner H, Krishnan J, Samarasekera D, Haber GP, Stein RJ, Kaouk JH (2014) Urine leak in minimally invasive partial nephrectomy: analysis of risk factors and role of intraoperative ureteral catheterization. Int Braz J Urol 40 (6): 763-771. doi: 10.1590/s1677-5538.Ibju.2014.06.07. |
| [13] | Kundu SD, Thompson RH, Kallingal GJ, Cambareri G, Russo P (2010) Urinary fistulae after partial nephrectomy. BJU Int 106 (7): 1042-1044. doi: 10.1111/j.1464-410X.2010.09230.x. |
| [14] | Zaid HB, Parker WP, Lohse CM, Cheville JC, Boorjian SA, Leibovich BC, Thompson RH Patient factors associated with 30-day complications after partial nephrectomy: A contemporary update. In: Urologic Oncology: Seminars and Original Investigations, 2017. vol 4. Elsevier, pp 153. e151-153. e156. |
| [15] | Kopp RP, Mehrazin R, Palazzi KL, Liss MA, Jabaji R, Mirheydar HS, Lee HJ, Patel N, Elkhoury F, Patterson AL (2014) Survival outcomes after radical and partial nephrectomy for clinical T 2 renal tumours categorised by RENAL nephrometry score. BJU international 114 (5): 708-718. |
| [16] | Long CJ, Canter DJ, Kutikov A, Li T, Simhan J, Smaldone M, Teper E, Viterbo R, Boorjian SA, Chen DY, Greenberg RE, Uzzo RG (2012) Partial nephrectomy for renal masses ≥ 7 cm: technical, oncological and functional outcomes. BJU Int 109 (10): 1450-1456. doi: 10.1111/j.1464-410X.2011.10608.x. |
| [17] | Bigot P, Hétet JF, Bernhard JC, Fardoun T, Audenet F, Xylinas E, Ploussard G, Pignot G, Bessede T, Ouzaid I, Robine E, Brureau L, Merigot De Treigny O, Maurin C, Long JA, Rouffilange J, Hoarau N, Lebdai S, Rouprêt M, Bastien L, Neuzillet Y, Mongiat-Artus P, Verhoest G, Zerbib M, Ravery V, Rigaud J, Bellec L, Baumert H, Chautard D, Bensalah K, Escudier B, Paparel P, Grenier N, Rioux-Leclercq N, Azzouzi AR, Soulié M, Patard JJ (2014) Nephron-sparing surgery for renal tumors measuring more than 7 cm: Morbidity, and functional and oncological outcomes. Clinical Genitourinary Cancer 12 (1): e19-e27. doi: 10.1016/j.clgc.2013.09.004. |
| [18] | Peyronnet B, Seisen T, Oger E, Vaessen C, Grassano Y, Benoit T, Carrouget J, Pradère B, Khene Z, Giwerc A, Mathieu R, Beauval JB, Nouhaud FX, Bigot P, Doumerc N, Bernhard JC, Mejean A, Patard JJ, Shariat S, Roupret M, Bensalah K, French Comittee of Urologic O (2016) Comparison of 1800 Robotic and Open Partial Nephrectomies for Renal Tumors. Annals of Surgical Oncology 23 (13): 4277-4283. doi: 10.1245/s10434-016-5411-0. |
| [19] | Kahn AE, Shumate AM, Ball CT, Thiel DD (2019) Elimination of surgical drains following robotic-assisted partial nephrectomy. J Robot Surg 13 (6): 741-745. doi: 10.1007/s11701-019-00922-5. |
| [20] | Abaza R, Prall D (2013) Drain placement can be safely omitted after the majority of robotic partial nephrectomies. The Journal of urology 189 (3): 823-827. |
| [21] | Malkoc E, Maurice MJ, Kara O, Ramirez D, Nelson RJ, Caputo PA, Mouracade P, Stein R, Kaouk JH (2017) Robot-assisted approach improves surgical outcomes in obese patients undergoing partial nephrectomy. BJU Int 119 (2): 283-288. doi: 10.1111/bju.13675. |
| [22] | Veeratterapillay R, Addla SK, Jelley C, Bailie J, Rix D, Bromage S, Oakley N, Weston R, Soomro NA (2017) Early surgical outcomes and oncological results of robot-assisted partial nephrectomy: a multicentre study. BJU international 120 (4): 550-555. |
| [23] | Ramirez D, Maurice MJ, Caputo PA, Nelson RJ, Kara Ö, Malkoç E, Kaouk JH (2016) Predicting complications in partial nephrectomy for T1a tumours: does approach matter? BJU international 118 (6): 940-945. |
| [24] | Mathieu R, Verhoest G, Droupy S, de la Taille A, Bruyere F, Doumerc N, Rischmann P, Vaessen C, Roupret M, Bensalah K (2013) Predictive factors of complications after robot-assisted laparoscopic partial nephrectomy: a retrospective multicentre study. BJU international 112 (4): E283-E289. |
| [25] | Wheat JC, Roberts WW, Hollenbeck BK, Wolf JS, Jr., Weizer AZ (2013) Complications of laparoscopic partial nephrectomy. Urol Oncol 31 (1): 57-62. doi: 10.1016/j.urolonc.2010.11.003. |
| [26] | Stroup SP, Palazzi K, Kopp RP, Mehrazin R, Santomauro M, Cohen SA, Patterson AL, L'Esperance JO, Derweesh IH (2012) RENAL nephrometry score is associated with operative approach for partial nephrectomy and urine leak. Urology 80 (1): 151-156. doi: 10.1016/j.urology.2012.04.026. |
| [27] | Carneiro A, Sivaraman A, Sanchez-Salas R, Di Trapani E, Barret E, Rozet F, Galiano M, Pizzaro FU, Doizi S, Cathala N (2015) Evolution from laparoscopic to robotic nephron sparing surgery: a high-volume laparoscopic center experience on achieving ‘trifecta’outcomes. World journal of urology 33 (12): 2039-2044. |
| [28] | Jelley CR, Kurukulaarachchi KASH, Forster L, Bardgett H, Singh R, Addla SK (2017) Comparison of open and robotic nephron sparing surgery: a single centre experience. Journal of Clinical Urology 10 (1): 28-35. doi: 10.1177/2051415816668942. |
| [29] | Tomaszewski JJ, Smaldone MC, Cung B, Li T, Mehrazin R, Kutikov A, Canter DJ, Viterbo R, Chen DY, Greenberg RE, Uzzo RG (2014) Internal validation of the renal pelvic score: a novel marker of renal pelvic anatomy that predicts urine leak after partial nephrectomy. Urology 84 (2): 351-357. doi: 10.1016/j.urology.2014.05.001. |
| [30] | Bruner B, Breau RH, Lohse CM, Leibovich BC, Blute ML (2011) Renal nephrometry score is associated with urine leak after partial nephrectomy. BJU Int 108 (1): 67-72. doi: 10.1111/j.1464-410X.2010.09837.x. |
| [31] | Potretzke AM, Knight BA, Zargar H, Kaouk JH, Barod R, Rogers CG, Mass A, Stifelman MD, Johnson MH, Allaf ME, Sherburne Figenshau R, Bhayani SB (2016) Urinary fistula after robot-assisted partial nephrectomy: a multicentre analysis of 1 791 patients. BJU Int 117 (1): 131-137. doi: 10.1111/bju.13249. |
| [32] | Girard F, Thanigasalam R, Theveniaud PE, El Hajj A, Eimer C, Sibileau E, Massoud W, Fennouri M, Baumert H (2014) Prolonged urinary leakage after partial nephrectomy: a novel management pathway. Urology 83 (2): 485-488. doi: 10.1016/j.urology.2013.09.006. |
| [33] | Pardalidis P, Andriopoulos N, Kosmaoglou E, Pardalidis N (2017) Massive Dilation of the Ureter: An Endoscopic Management of Persistent Urinary Leak After Partial Nephrectomy. J Endourol Case Rep 3 (1): 186-188. doi: 10.1089/cren.2017.0102. |
| [34] | Gorsi U, Kumar S, Tyagi S, Sharma A (2020) A novel approach to postrobot-assisted nephron-sparing surgery persistent urinary leak - Can we glue? Indian J Urol 36 (1): 62-64. doi: 10.4103/iju.IJU_209_19. |
| [35] | Seo IY, Lee YH, Rim JS (2008) Case report: percutaneous fibrin glue injection for urine leakage in laparoscopic partial nephrectomy. Journal of endourology 22 (5): 959-962. |
| [36] | Aslan G, Men S, GüLCü A, Kefi A, Esen A (2005) Percutaneous embolization of persistent urinary fistula after partial nephrectomy using N-butyl-2-cyanoacrylate. International journal of urology 12 (9): 838-841. |
| [37] | Chu W, Chien GW, Finley DS (2015) Novel ureteroscopic technique for treatment of prolonged caliceal leak after partial nephrectomy. J Endourol 29 (4): 397-400. doi: 10.1089/end.2014.0441. |
| [38] | Mues AC, Landman J, Gupta M (2010) Endoscopic management of completely excluded calices: a single institution experience. J Endourol 24 (8): 1241-1245. doi: 10.1089/end.2009.0663. |
| [39] | Nohara T, Matsuyama S, Kawaguchi S, Miyagi T, Seto C, Mochizuki K (2016) Usefulness of selective renal artery embolization for urinary fistula following partial nephrectomy: Two case reports. Mol Clin Oncol 5 (1): 158-160. doi: 10.3892/mco.2016.885. |
| [40] | Godoy G, Katz DJ, Adamy A, Jamal JE, Bernstein M, Russo P (2011) Routine drain placement after partial nephrectomy is not always necessary. J Urol 186 (2): 411-415. doi: 10.1016/j.juro.2011.03.151. |
| [41] | Delto JC, Chang P, Hyde S, McAnally K, Crociani C, Wagner AA (2019) Reducing Pseudoaneurysm and Urine Leak After Robotic Partial Nephrectomy: Results Using the Early Unclamping Technique. Urology 132: 130-135. doi: 10.1016/j.urology.2019.05.042. |
| [42] | Mehra K, Manikandan R, Dorairajan LN, Sreerag S, Jain A, Bokka SH (2019) Trifecta Outcomes in Open, Laparoscopy or Robotic Partial Nephrectomy: Does the Surgical Approach Matter? Journal of Kidney Cancer and VHL 6 (1): 8. |
| [43] | Wang Y, Shao J, Ma X, Du Q, Gong H, Zhang X (2017) Robotic and open partial nephrectomy for complex renal tumors: a matched-pair comparison with a long-term follow-up. World journal of urology 35 (1): 73-80. |
| [44] | Janda G, Deal A, Yang H, Nielsen M, Smith A, Pruthi RS, Wallen E, Woods M, Raynor M (2016) Single-institution experience with robotic partial nephrectomy for renal masses greater than 4 cm. Journal of endourology 30 (4): 384-389. |
| [45] | Ganpule AP, Goti AG, Mishra SK, Sabnis RB, Desai MM, Desai MR (2015) Robotic-assisted laparoscopic partial nephrectomy: A single centre Indian experience. Journal of minimal access surgery 11 (1): 78. |
| [46] | Satkunasivam R, Tsai S, Syan S, Bernhard J-C, de Castro Abreu AL, Chopra S, Berger AK, Lee D, Hung AJ, Cai J (2015) Robotic unclamped “minimal-margin” partial nephrectomy: ongoing refinement of the anatomic zero-ischemia concept. European urology 68 (4): 705-712. |
| [47] | Hu JC, Treat E, Filson CP, McLaren I, Xiong S, Stepanian S, Hafez KS, Weizer AZ, Porter J (2014) Technique and outcomes of robot-assisted retroperitoneoscopic partial nephrectomy: a multicenter study. European urology 66 (3): 542-549. |
| [48] | Vittori G (2014) Open versus robotic-assisted partial nephrectomy: a multicenter comparison study of perioperative results and complications. World journal of urology 32 (1): 287-293. |
| [49] | Alyami FA, Rendon RA (2013) Laparoscopic partial nephrectomy for >4 cm renal masses. Can Urol Assoc J 7 (5-6): E281-286. doi: 10.5489/cuaj.1003. |
| [50] | Tanagho YS, Kaouk JH, Allaf ME, Rogers CG, Stifelman MD, Kaczmarek BF, Hillyer SP, Mullins JK, Chiu Y, Bhayani SB (2013) Perioperative complications of robot-assisted partial nephrectomy: analysis of 886 patients at 5 United States centers. Urology 81 (3): 573-580. |
| [51] | Porpiglia F, Bertolo R, Amparore D, Fiori C (2013) Margins, ischaemia and complications rate after laparoscopic partial nephrectomy: impact of learning curve and tumour anatomical characteristics. BJU international 112 (8): 1125-1132. |
| [52] | Ficarra V, Bhayani S, Porter J, Buffi N, Lee R, Cestari A, Mottrie A (2012) Predictors of warm ischemia time and perioperative complications in a multicenter, international series of robot-assisted partial nephrectomy. European urology 61 (2): 395-402. |
| [53] | Lucas SM, Mellon MJ, Erntsberger L, Sundaram CP (2012) A comparison of robotic, laparoscopic and open partial nephrectomy. Jsls 16 (4): 581-587. doi: 10.4293/108680812x13462882737177. |
| [54] | Bylund JR, Clark CJ, Crispen PL, Lagrange CA, Strup SE (2011) Hand-assisted laparoscopic partial nephrectomy without formal collecting system closure: perioperative outcomes in 104 consecutive patients. J Endourol 25 (12): 1853-1857. doi: 10.1089/end.2011.0175. |
| [55] | Mues AC, Okhunov Z, Haramis G, Landman J (2011) Contemporary experience with laparoscopic partial nephrectomy. Journal of Laparoendoscopic & Advanced Surgical Techniques 21 (4): 323-327. |
| [56] | Pierorazio PM, Patel HD, Feng T, Yohannan J, Hyams ES, Allaf ME (2011) Robotic-assisted versus traditional laparoscopic partial nephrectomy: comparison of outcomes and evaluation of learning curve. Urology 78 (4): 813-819. |
| [57] | Spana G, Haber G-P, Dulabon LM, Petros F, Rogers CG, Bhayani SB, Stifelman MD, Kaouk JH (2011) Complications after robotic partial nephrectomy at centers of excellence: multi-institutional analysis of 450 cases. The Journal of urology 186 (2): 417-422. |
| [58] | Scoll BJ, Uzzo RG, Chen DY, Boorjian SA, Kutikov A, Manley BJ, Viterbo R (2010) Robot-assisted partial nephrectomy: a large single-institutional experience. Urology 75 (6): 1328-133. |
| [59] | Sammon J, Petros FG, Sukumar S, Bhandari A, Kaul S, Menon M, Rogers C (2011) Barbed suture for renorrhaphy during robot-assisted partial nephrectomy. J Endouro 23 (3) 529-33: J Endourol. 2011 Mar; 25 (3): 529-33. |
APA Style
Kwabena Nkansah-Amankra, Ameisha Tutwiler, Zane Giffen, Alberto Breda, Wesley Ekeruo, et al. (2023). Urine Leak After Partial Nephrectomy: A Rare Complication After Robot-Assisted Partial Nephrectomy. International Journal of Clinical and Experimental Medical Sciences, 9(2), 29-41. https://doi.org/10.11648/j.ijcems.20230902.13
ACS Style
Kwabena Nkansah-Amankra; Ameisha Tutwiler; Zane Giffen; Alberto Breda; Wesley Ekeruo, et al. Urine Leak After Partial Nephrectomy: A Rare Complication After Robot-Assisted Partial Nephrectomy. Int. J. Clin. Exp. Med. Sci. 2023, 9(2), 29-41. doi: 10.11648/j.ijcems.20230902.13
AMA Style
Kwabena Nkansah-Amankra, Ameisha Tutwiler, Zane Giffen, Alberto Breda, Wesley Ekeruo, et al. Urine Leak After Partial Nephrectomy: A Rare Complication After Robot-Assisted Partial Nephrectomy. Int J Clin Exp Med Sci. 2023;9(2):29-41. doi: 10.11648/j.ijcems.20230902.13
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Download@article{10.11648/j.ijcems.20230902.13,
author = {Kwabena Nkansah-Amankra and Ameisha Tutwiler and Zane Giffen and Alberto Breda and Wesley Ekeruo and Firas Petros and Obi Ekwenna},
title = {Urine Leak After Partial Nephrectomy: A Rare Complication After Robot-Assisted Partial Nephrectomy},
journal = {International Journal of Clinical and Experimental Medical Sciences},
volume = {9},
number = {2},
pages = {29-41},
doi = {10.11648/j.ijcems.20230902.13},
url = {https://doi.org/10.11648/j.ijcems.20230902.13},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcems.20230902.13},
abstract = {In this systematic review, we looked at the rate of urine leakage from the kidney after surgical removal of kidney tumors. Urine leak (UL) is a common post-operative complication of partial nephrectomy (PN). The reported incidence varies in the literature, and there are no well-established guidelines for management of UL after PN. The goal of this study is to report the incidence and most common management strategies for UL after PN. For our quantitative synthesis, a systematic review of articles related to UL after PN from April 2010 to April 2020 was performed using PubMed and EMBASE. 475 total records were found, of which 40 reported on post-operative UL. A total of 19,904 cases were included. The overall incidence of UL was 2.8% (554/20,140). UL was most common in open cases (5.01%), followed by laparoscopic (4.40%) and robotic (1.18%) PN. Thirty-one of the included studies reported on management technique for a total of 343 interventions. UL was most frequently managed non-operatively (46.6%). Other management strategies included cystoscopy with ureteral stent placement (39.4%), percutaneous drain placement (8.7%), and percutaneous nephrostomy tube placement (2.3%). Use of nephrectomy, open reconstruction, angioembolization, or ureteroscopic techniques was uncommon (3.1%). Our study revealed that UL is rare after robotic approach to PN. Many reported cases have been managed conservatively. A stepwise management strategy is recommended. Most of these leaks heal with time or with placement of a stent into the ureter after surgery. We found that urine leak is less common with robotic surgery versus open or laparoscopic surgery.},
year = {2023}
}
TY - JOUR T1 - Urine Leak After Partial Nephrectomy: A Rare Complication After Robot-Assisted Partial Nephrectomy AU - Kwabena Nkansah-Amankra AU - Ameisha Tutwiler AU - Zane Giffen AU - Alberto Breda AU - Wesley Ekeruo AU - Firas Petros AU - Obi Ekwenna Y1 - 2023/05/10 PY - 2023 N1 - https://doi.org/10.11648/j.ijcems.20230902.13 DO - 10.11648/j.ijcems.20230902.13 T2 - International Journal of Clinical and Experimental Medical Sciences JF - International Journal of Clinical and Experimental Medical Sciences JO - International Journal of Clinical and Experimental Medical Sciences SP - 29 EP - 41 PB - Science Publishing Group SN - 2469-8032 UR - https://doi.org/10.11648/j.ijcems.20230902.13 AB - In this systematic review, we looked at the rate of urine leakage from the kidney after surgical removal of kidney tumors. Urine leak (UL) is a common post-operative complication of partial nephrectomy (PN). The reported incidence varies in the literature, and there are no well-established guidelines for management of UL after PN. The goal of this study is to report the incidence and most common management strategies for UL after PN. For our quantitative synthesis, a systematic review of articles related to UL after PN from April 2010 to April 2020 was performed using PubMed and EMBASE. 475 total records were found, of which 40 reported on post-operative UL. A total of 19,904 cases were included. The overall incidence of UL was 2.8% (554/20,140). UL was most common in open cases (5.01%), followed by laparoscopic (4.40%) and robotic (1.18%) PN. Thirty-one of the included studies reported on management technique for a total of 343 interventions. UL was most frequently managed non-operatively (46.6%). Other management strategies included cystoscopy with ureteral stent placement (39.4%), percutaneous drain placement (8.7%), and percutaneous nephrostomy tube placement (2.3%). Use of nephrectomy, open reconstruction, angioembolization, or ureteroscopic techniques was uncommon (3.1%). Our study revealed that UL is rare after robotic approach to PN. Many reported cases have been managed conservatively. A stepwise management strategy is recommended. Most of these leaks heal with time or with placement of a stent into the ureter after surgery. We found that urine leak is less common with robotic surgery versus open or laparoscopic surgery. VL - 9 IS - 2 ER -
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